No More Colonoscopies! (For Most of Us)

If you’re approaching 50, you’re facing issues unique to your next half century. Oh, sure, there are lots of good things to anticipate, like joining AARP for discounts on Depends or joining one of their affordable bus tours to the Dells. You can even fantasize about retirement, though it may be years and years away.

With my own colonoscopy experience now behind me (so to speak), let me reassure colonoscopy virgins that the procedure is sort of anti-climactic, almost peaceful in its fashion. With 5.5 feet of fiberoptic tubing deep within my large intestine, I expected more drama. Among life’s experiences, I’d place the colonoscopy at easier than a root canal but more challenging than a paper cut or bad haircut.

But now you can draw a line through (rather than under) “get a colonoscopy” on your list of after-50 tasks.

Aren’t you glad you lived to see this day?

Cologuard approved
A couple weeks ago, the FDA approved a test called Cologuard, which uses DNA analysis of a stool specimen to screen you for colon cancer and pre-cancerous colon polyps. Moreover, because the test is quite a bit less expensive than a colonoscopy (in which both the gastroenterologist and the outpatient facility have to be paid), health insurance companies seem to be cooperating when it comes to paying for Cologuard.

The company that developed Cologuard, Exact Sciences, submitted data on 10,000 patients. When the test showed a diagnostic accuracy of 92% (about the same as a colonoscopy), the FDA was impressed.

If your Cologuard test result comes out positive, you’ll obviously need an eyes-on colonoscopy to locate and eventually remove any problem areas. If negative, repeat the Cologuard a decade later.

In rare cases, there are false-positive results (test is positive, follow-up colonoscopy is negative) as well as false-negatives (the test misses a cancer). Realize, though, that even a colonoscopy can miss a cancer. In this unnerving case, if you’re following the rules of getting an annual stool test for blood (part of a routine physical), any missed cancer will still be picked up early.

No more cherry-flavored laxative
Just think! With a Cologuard you’ll miss drinking that quart of cloying laxative that turns your intestines into Mount St. Helens until they’re clean enough to glow. You’ll also avoid the endless back-and-forth to your toilet and that ride to the hospital with your pelvic floor muscles locked tight (“Honey, please, do not hit another pothole!). You won’t have to watch your large intestine being explored up there on the monitor, and you’ll miss the cheery, “You’re fine, no cancer,” from your gastroenterologist. Finally, you’ll sidestep the experience of passing more post-colonoscopy gas than you knew any human could hold.

The test was devised for people over 50 at average risk. There are a few people for whom the Cologuard test is not advised, primarily those with a greater-than-average risk for developing colon cancer. These include patients with inflammatory bowel disease (ulcerative colitis and Crohn’s), previous colon cancers, and certain genetic susceptibilities to colon cancer. You also cannot have had recent large-intestine issues like diarrhea or rectal bleeding (hemorrhoids, fissures). Menstruating women should do the test between periods, since a little menstrual blood inadvertently mixed with stool can lead to a false-positive result.

Want to try the new test?
If you want to proceed and you’re a WholeHealth Chicago patient, call and schedule lab-only, and please bring your insurance card. This visit is mainly for paperwork, but requires your signature and thus cannot be done online. Our staff will complete the form, copy your card, and fax everything to the people at Cologuard. (If you’re not a WHC patient, ask your primary care doctor for information.)

Doctors’ offices are not supplied with the test kits, just FYI.

You’ll next receive a call from a Cologuard representative who will review your insurance and may, depending of your insurance company, ask you to pay a $50 advance to cover the kit, shipping charges, and the time spent getting prior authorization for insurance approval. This charge does not apply to Medicare patients since Medicare recently fully approved this test.

Once coverage is approved Cologuard will mail you the kit, complete with collection instructions vaguely reminiscent of Mr. Hanky, the Christmas poo character from South Park.

You mail the kit back to them, your test results will be sent to our office, and we’ll contact you.

Paying for Cologuard
If you’re at all familiar with the chicaneries of health insurance you know that “approval” is not the same as “payment.” Cologuard will work to seek full payment (including filing appeals), and you’ll receive in the mail an Explanation of Benefits from your insurer, with the reminder that “This is Not a Bill.”

When all is said and done, like just about everything in health care reimbursement, if your insurer does not pay the full balance after Cologuard’s efforts, the remaining portion becomes your responsibility. If you do get a bill, it may arrive months and months after your test is completed.

Keep in mind that colon cancer is one of the most preventable and yet least prevented cancers in the US today. It’s the third most diagnosed cancer, the second leading cause of cancer deaths in both sexes over 50, and one of the most treatable cancers if found early through a screening test.

Yet one in three adults over 50 still aren’t getting screened as recommended. If you’re in this group, let the Cologuard test change your world.

I’m doing my own this week. Yes, to be honest, I’d rather be in Paris, or even the Dells, than busy collecting my specimen, but then again, I, too, want to…

Dr. Edelberg, you crack me up! Only you would add South Park references to a post about colon cancer screenings. In all seriousness though, as a woman in her 30’s whose big sister’s gastrointerologist insisted! that she tell all of us younger siblings we needed to be screened starting at 45, not 50, I’m very pleased to hear about this new test! No offense intended at all, Dr. E, I love you much, but we see each other plenty as is.

WOW! I’m NOT shooting this messenger! I lost my colon virginity last year as I was a 65 year old chicken and procrastinator. I’d rather still be a virgin but that is all BEHIND me. (Pardon the pun) Thanks so much for this article and I absolutely LOVE your sense of humor especially on such a sticky subject. Also, thanks for reminding me about getting an annual checkup.

Thanks for this encouragement to get checked out. I’m sure many of us know someone whose life has been saved by a colonoscopy which discovered a pre-cancerous polyp. That happened to me at age 40, to my Dad in his 70’s. His Dad, my grandad, died of colon cancer at age 59.

One question: do you recommend this test for individuals like me who’ve already had at least one pre-cancerous polyp removed or should we get a colonoscopy every 5 years or so?

I’ve had digestive problems almost all my life, especially in my colon. Diagnosed with ulcerative colitis at age 15. Had it most of my adult life (except during my 20’s when I was smoking and leading a decadent lifestyle, it went into remission – something about nicotine’s effect on the colitis, but decades later nicotine patches didn’t have the same effect). Generally, 10+ years of continuous inflammation of most cells greatly increases the risk it will develop into cancer…..

So, sure enough, diagnosed with colon cell dyplasia in my 40’s and cancer at age 50. So I had my colon removed. The reason for the story is to provide background for my recommendation coming from someone who has had too many colonoscopies + a colon cancer survivor (no recurrence in these 14 years since my operation 🙂 Plus I learned a lot when doing consulting work with the professional society for endoscopists….

My recommendation: I don’t think people should stop all colonoscopies just because of this test. Why? Polyps often develop in the colon that have no dysplastic cells yet – no pre-cancer. Yet those polyps are one of the most likely places in the colon to develop cancer later. A colonoscopy always involves removing all polyps, so the colonoscopy isn’t only diagnostic, it’s preventative. Because colon cancer is one of the slowest growing cancers, I think the safest route to take is get a colonoscopy every 5-7 years after age 45 and to screen for cancer every 2 years in between those. Why would you want to wait until the cells begin to mutate in one or more polyps to do anything, when you can remove them as a potential cancer hot spot?

My recommended years between colonoscopies & Cologuard tests is a bit of a guess. A gastroenterologist would be best able to give you the safest, but also most cost effective interval between the different types of tests, GE’s are the specialists who do colonoscopies, ERCP’s (running a scope into your digestive system from the other end – down your throat, but you’re put all the way under for this or your gag reflex goes into high gear), and newer non-intrusive scoping using a small swallowed capsule containing a wireless camera they use to observe and record the entire journey through your digestive system. It could be more years than I said between each type of diagnostic. My key point isn’t the interval – its to still get an occasional colonoscopy to remove polyps to prevent them from ever becoming cancerous!

I shouldn’t be posting comments at 3 am 🙂 Did I get the name of the specialist wrong on my last post? It was supposed to be gastroendoscopist but I’m not sure if that’s what my tired mind communicated. Please correct if wrong and delete this comment. Thanks for your excellent site!

When you sign up to receive Health Tips, you can look forward to Dr. Edelberg’s smart and very current observations arriving in your in-box weekly. They’re packed with helpful information and are often slightly irreverent. One of the most common responses to the tips is “I wish my doctor talked to me like this!”

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